Agenda - 12-11-2007-6d - Laserfiche WebLink

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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28. 2009 National Flood Insurance Program Important: Read the instructions on pages 1-8. r'o SECTION A -PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name Governmental Services Annex PoUcy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Company NAIC Number I Cameron Street City Hillsborough State NC ZIP Code 27278 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) south side of East Margaret Lane A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) open public market A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ^ NAD 1927 ®NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 7 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) 7.745 sq ft a) Square footage of attached garage na sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in SECTION B -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number B2. County Name B3. State Orange County -- 370342 Orange County North Carolina B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 9874 J 02/02/2007 02/02(2007 AE 506.8 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ® FIS Profile ^ FIRM ^ Community Determined ^ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ^ NGVD 1929 ®NAVD 1988 ^ Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ^Yes ®No Designation Date ^CBRS ^ OPA -- SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ^ Construction Drawings* ^ Building Under Construction* ®Finsshed Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ ^ feet ^ meters (Puerto Rico only) b) Top of the next higher floor ^ feet ^ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) ^ feet ^ meters (Puerto Rico only) d) Attached garage (top of slab) ^ feet ^ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building ^ feet ^ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) ^ feet ^ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) ^ feet ^ meters (Puerto Rico only) SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certiticate represents my best efforts to interpret the data available. r 1 understand that any false statement maybe punishable by fine or imprisonment under 18 U. S. Code, Section 1001. ^ Check here if comments are provided on back of form. Certifler's Name License Number Title Company Name Address City State ZIP Code Signature Date Telephone i,.x Fi S..ga E,» a~~^S E ~}t3.... i-IEI'~~. FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions